Correlation between MRI Grading System and Surgical Findings for Lumbar Foraminal Stenosis

OBJECTIVE: Magnetic resonance imaging (MRI) grading systems using sagittal images are useful for evaluation of lumbar foraminal stenosis. We evaluated whether such a grading system is useful as a diagnostic tool for surgery. METHODS: Between July 2014 and June 2015, 99 consecutive patients underwent unilateral lumbar foraminotomy for lumbar foraminal stenosis. Surgically confirmed foraminal stenosis and the contralateral, asymptomatic neuroforamen were assessed based on a 4-point MRI grading system. Two experienced researchers independently evaluated the MR sagittal images. Interobserver agreement and intraobserver agreement were analyzed using κ statistics. RESULTS: The mean age of patients (54 women, 45 men) was 62.5 years. A total of 101 levels (202 neuroforamens) were evaluated. MRI grades for operated neuroforamens were as follows: Grade 0 in 0.99%, Grade 1 in 5.28%, Grade 2 in 14.85%, and Grade 3 in 78.88%. Interobserver agreement was moderate for operated neuroforamens (κ=0.511) and good for asymptomatic neuroforamens (κ=0.696). Intraobserver agreement by reader 1 for operated neuroforamens was good (κ=0.776) and that for asymptomatic neuroforamens was very good (κ=0.831). In terms of lumbar level, interobserver agreement for L5–S1 (κ=0.313, fair) was relatively lower than the other level (κ=0.804, very good). CONCLUSION: MRI grading system for lumbar foraminal stenosis is thought to be useful as a diagnostic tool for surgery in the lumbar spine; however, it is less reliable for symptomatic L5–S1 foraminal stenosis than for other levels. Thus, various clinical factors as well as the MRI grading system are required for surgical decision-making.

Personality Characteristics of Mothers of Children with Attention Deficit Hyperactivity Disorder as Assessed by the Minnesota Multiphasic Personality Inventory

OBJECTIVE: The current study investigated the personality characteristics of mothers of children with attention deficit hyperactivity disorder (ADHD) using the Minnesota Multiphasic Personality Inventory (MMPI). METHODS: Fifty mothers (average age of 38.1+/-4.2 years) of children with ADHD not having comorbidity (37 boys, 13 girls; average age of 8.5+/-1.9 years) and 59 mothers (average age of 38.1+/-2.7 years) of comparison children (37 boys, 13 girls; average age of 8.1+/-1.5 years) completed the Korean version of the MMPI. Only mothers whose psychiatric health was verified by the Structured Clinical Interview for axis-I DSM-IV disorders (SCID-IV) were included in current study. RESULTS: After controlling for maternal age, maternal education level, children's gender, age, and total and verbal intelligence quotient (IQ), the MMPI scores of the mothers of children with ADHD were significantly higher on the depression (D), hysteria (Hy) and psychasthenia (Pt) scales than those of the mothers of children in the comparison group. CONCLUSION: These results suggested that even psychologically healthy mothers of children with ADHD alone might be depressed, histrionic and anxious.

Fungal Myositis in Children: Serial Ultrasonographic Findings

PURPOSE: To evaluate serial ultrasonographic findings of fungal myositis in children. MATERIALS AND METHODS: Eleven lesions caused by fungal myositis and occurring in six children were included in this study. Eight lesions in five children were histopathologically proven and the other three were clinically diagnosed. Serial ultrasonographic findings were retrospectively evaluated in terms of size, location, margin, internal echotexture and adjacent cortical change occurring during the follow-up period ranging from five days to two months. RESULTS: Three patients (50%) had multiple lesions. The sites of involvment were the thigh (n=4), calf (n=3), chest wall (n=2), abdominal wall (n=1) and forearm (n=1). Initially, diffuse muscular swelling was revealed, with ill-defined hypoechoic lesions confined to the muscle layer (n=8). Follow-up examination of eight lesions over a period of 5-10 days showed that round central echogenic lesions were surrounded by previous slightly echogenic lesions (n=6, 75%). Long-term follow-up of five lesions over a two-month period revealed periosteal thickening in one case (20%), and the peristence of echogenic solid nodules in four (80%). Pathologic examination showed that the central lesions correlated with a fungus ball and the peripheral slightly echogenic lesions corresponded to hematoma and necrosis. CONCLUSION: Serial ultrasonographic findings of fungal myositis in children revealed relatively constant features in each case. In particular, the findings of muscular necrosis and a fungus ball over a period of 5-14 days were thought to be characteristic.